The Journal of Hand Surgery - European Volume - April 2018 - 12

S12
technique, performed by a musculoskeletal radiologist (non-surgical group) and fluoroscopic-guided
injection performed by hand surgeons in an operating
theatre (surgical group). Secondary outcome measures included elapsed time from point of 'decision to
treat' to the delivery of treatment and patient
experience.
Method: A retrospective evaluation of activity across
a single financial year, Healthcare Resource Group
codes and tariffs for both study arms was conducted
through data derived from an electronic radiology
outpatient booking system and theatre procedure
logs.
Results: 68 patients involving 72 joints were identified in the non-surgical group. 15 patients involving
18 joints were identified in the surgical group. The
cumulative tariff of steroid injections performed surgically was significantly greater than that performed
in the radiology department. The average time from
point of 'decision to treat' to the delivery of treatment
was 82 days (23-216) in the surgical group compared
to 66 days in the non-surgical group (30-97).
Conclusion: Ultrasound-assisted steroid injections
performed in the outpatient setting currently provide
a better patient experience and can be a solution to
surgical waiting times for elective hand procedures.
It offers significant cost savings, in a climate of a
resource-depleted NHS.

Postcode Lottery - Do Commissioning Groups Differ
in Funding Elective Hand Surgery?
Miss Kirsty Smith and Mr James Haeney
Hull Royal Infirmary
Time in programme: Friday 4th May 2018 09:33

Aims: To determine if there are regionaldifferences
in CCG funding of elective hand surgery.
Methods: Welooked at each of the 207 English CCG
commissioning policiesto review publishedcriteria
for routinely commissioned elective hand surgery.
We specifically reviewed funding availability for surgical treatment of Carpal tunnel syndrome, trigger
digit, Dupuytren's andganglion.
Results: Referral criteria forsurgical release oftrigger finger was the most consistent area with the
majority of CCGsprovidingfunding for a fixed flexion
deformity or after failed conservative management of
symptomatic triggering.However the type and length
of conservative management differed greatly.
Referral criteria forDupuytren's diseasevaried
greatly. Some CCGs allow treatment of any

Journal of Hand Surgery (Eur) 43(Supplement 1)
Dupuytren's whereas others specify angles of joint
contracture.
MostCCGs fund carpal tunnel decompression in
severe disease with muscle wasting and sensoryblunting, but availability of treatment for less
severe disease is more variable. The length and
typeof recommended conservative treatment formoderate symptomsranged considerably.
Ganglion surgery is not routinely funded by the
majority of CCGs. In some areas treatment is available on an IFR basis only whereas other CCGs publish specific criteria for mucous cysts, seed ganglia
and functional impairment.
Conclusions: Significant differences exist in the
regional CCG funded availability of elective hand surgery in England.

Hand Trauma in England: An Analysis of HES Data
Mr Oliver Manley, Mr Justin Wormald and
Prof Dominic Furniss
Stoke Mandeville Hospital
Time in programme: Friday 4th May 2018 09:37

Introduction: Hospital episode statistics provide a
method to study changes in the incidence of hand
injuries over time that can be used to target
resources and identify research targets.
Methods: We analysed freely available hospital episode statistics between 1998 and 2014 for hand and
wrist fractures, tendon, nerve and blood vessel injuries, nail bed injuries, and traumatic amputations.
The incidence of each injury type was calculated by
age group using population data from the Office for
National Statistics.
Results: There were a total of 845890 hand injuries
recorded over the 17-year period studied, of which
76% occurred in men. The incidence of hand injuries
each year increased from 70 to 110 per 100 000. Hand
fractures were the most common injury, 51% of the
total, and the injury with the greatest rise in incidence. Notably, the incidence in the over 75 age
group doubled over the period studied. There was
also a large rise in the number of nail bed injuries,
particularly in the paediatric population, where the
incidence tripled.
Conclusion: This study describes the trends in
burden of hand trauma in England, and can be used
to predict future resource need for hand surgery services. The large rise in hand fractures in the elderly
and of nail bed injuries in children are notable and
require further study.



Table of Contents for the Digital Edition of The Journal of Hand Surgery - European Volume - April 2018

The Journal of Hand Surgery - European Volume - April 2018 - Cover1
The Journal of Hand Surgery - European Volume - April 2018 - Cover2
The Journal of Hand Surgery - European Volume - April 2018 - 1
The Journal of Hand Surgery - European Volume - April 2018 - 2
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The Journal of Hand Surgery - European Volume - April 2018 - 11
The Journal of Hand Surgery - European Volume - April 2018 - 12
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The Journal of Hand Surgery - European Volume - April 2018 - Cover3
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